After years of training, you’re confident that you’ve done what it takes to practice medicine. Rightfully so! You’ve put in time and energy. You’ve amassed education. You’re ready to move forward with your career.
But there’s a lot to do before you and your employer ink a contract. You’ll have to network far and wide, craft an effective curriculum vitae and polish your interview skills. And don’t forget about licensure and credentials. Those nitty-gritty tasks can make or break a job search.
“Preparation is key for everything about your medical career,” says Kevin Caldwell, senior director of Federation of State Medical Boards (FSMB) in Euless, Texas. “Your training is one gauge of success, but you still need to understand and be diligent about the other measures. Remember, things don’t necessarily come to those who wait, so be proactive about them too.”
As a graduating resident or fellow, you might already have an unrestricted medical license in the state where you plan to work. If not, you’ll need to secure a license to practice independently. No matter what state you’re in, you’ll have to be proactive, organized, responsive and thorough to navigate the licensure process effectively.
Timeliness Counts. It’s never too early to get the licensure ball rolling. Whether you’re working with a medical or osteopathic board, staffers love candidates who prepare for the unexpected instead of expecting miracles. “There’s nothing worse than receiving a phone call demanding to know when a license will be issued, and we’ve had the application for less than a week,” says Dawn Thompson, licensing manager at Washington State Medical Commission in Tumwater, Washington. “Worse yet [is when] we haven’t received one at all.”
The licensing timeline varies on a state-by-state and case-by-case basis. If your application is uncomplicated—as is generally the case with new physicians—the process may take two to three months or even less. If your training and history is complex, however, licensure could take six to nine months or even longer.
For instance, although most Iowa Board of Medicine candidates receive their licenses within 60 to 90 days, the timeframe is usually a bit shorter for physicians just out of residency because there’s less to evaluate. “They just have thinner files,” says Natalie Sipes, director of licensure of the Iowa Board of Medicine in Des Moines, allowing for quicker processing.
The onus is on you to know your medical or osteopathic board’s schedule and meet it. In some states, staff members issue unrestricted licenses administratively, which means you don’t have to wait for a formal vote. Once they establish that you’ve met the criteria with no residual concerns, they can process your application relatively quickly. But if you’re dependent on direct board involvement, you need to pay even more attention to deadlines and schedules. Member-panels don’t always meet monthly and often break for seasonal and other reasons. Make sure officials have your file well in advance of the next session so you’re not left waiting.
Alexis Smith, D.O., learned that the hard way. She was scheduled to begin a women’s imaging fellowship at the University of Pittsburgh Medical Center Magee-Womens’ Hospital on July 1, 2013. But even though Smith submitted her paperwork in March, she had to wait an extra month to begin her program because the board still hadn’t issued its approval. Several scheduled breaks slowed down the process.
Smith advises other physicians plan ahead for breaks like these. “You need to be careful about the schedule and get started as early as you can,” says Smith, now director of breast imaging of Trinity Health System in Steubenville, Ohio. “Otherwise you could have issues.” Caldwell agrees, saying, “Get it out of the way early in case there are any hiccups.”
Organization is a must. Although you can’t control how long it takes for a medical board to review your credentials or for an employer to offer you a job, you can help expedite the process. Start by knowing what’s expected of you.
No matter where you live, licensure paperwork focuses on your core credentials: proof of your identity and documentation that you’ve successfully completed every phase of your training. This includes passing the United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA).
Each state has its own requirements. If your target state is Iowa, you’ll have to complete a two-part package including the FSMB’s Uniform Application for Physician State Licensure covering the basics, in addition to a state-specific addendum. This addendum’s 23 questions ask about problems in medical school or residency as well as other salient issues: leaves of absence, malpractice charges, criminal histories and any impairments that might affect your ability to practice safely.
Depending on your state, you may also have to take a test or mini-course to demonstrate that you understand the state’s practice regulations and are up to speed on CPR and issues such as family violence, bio-terrorism, etc.
Most medical and osteopathic boards have online applications with forms and checklists for applicants and their primary sources. That’s one reason Anastasia Benson, D.O., had a relatively easy time securing an unrestricted license from the Texas Medical Board, despite its sheer volume of applicants. A graduate of Arizona College of Osteopathic Medicine, she initiated the process when she came home to Lone Star state to complete a family medicine residency. Everything she needed was posted online, including a required jurisprudence test.
Benson heeded others’ advice not to skim the website. She read the instructions thoroughly, which helped her get licensed and ready to launch her career. “I was in one of the hardest states to get a license,” she says, “but it wasn’t a traumatizing experience.” Benson now focuses on her practice, Paradigm Family Health, in Dallas.
Whatever your state, be prepared to get into the weeds. In addition to certified copies of documents, you’ll need to provide names, dates and contact information for verification. Since you’ll likely be asked repeatedly for the same history, it’s smart to create your own centralized folder. That way, you can quickly verify requests or correct information forwarded about you.
Brandi Ring, M.D., learned just how important an easily accessible credentials file is while she was moving to Colorado from Pennsylvania. In the midst of her process, she realized a form she needed was stashed in a moving van box. A member of Mile High OB/GYN Associates in Denver, Ring doesn’t skip a beat now when applying for new hospital privileges or clinical position/faculty appointments. Everything is within reach. “If you can, create a place where all of that information is easily organized and you can grab it in just seconds,” she says.
Take advantage of FCVS. The Federation Credentials Verification Service (FCVS) can help you create a permanent, vetted version of your history. FCVS is a clearinghouse for gathering, authenticating and storing primary source-verified credentials. Its physician profile will centralize a confidential, lifetime portfolio that you can easily forward. Medical and osteopathic boards in 12 states now require FCVS profiles, and the remaining states plus the District of Columbia accept them.
There are some downsides to FCVS. A profile costs a $350 base fee plus surcharges, and physicians still have to complete their state’s licensure applications, which may include vetting credentials not included in FCVS. However, the system can be beneficial if you’re applying for multiple state licenses now or in the future.
The FCVS may also be useful if you graduated from a medical school outside the U.S. and Canada. Verifications from foreign countries, especially war-torn regions, are often difficult, time-consuming and costly, so having one entity collect, certify, disseminate and store your dossier helps. “With all of the upheaval, it’s really a smart investment to get those credentials out of the country and into the U.S.,” says Lynnette Daniels, chief of licensing for the Nevada State Board of Medical Examiners in Reno. “It a one-and-done process, and they’re held for perpetuity.”
Ricardo R. Correa Marquez, M.D., Es. D, FACP, CMQ, found that to be true when he applied to The Warren Alpert Medical School of Brown University’s Hallett Center for Diabetes and Endocrinology in Providence, Rhode Island. He had previously done verification paperwork in Florida, Maryland, the District of Columbia and Georgia without the FCVS.
When Rhode Island required Marquez to use the FCVS, he realized how useful the service was. He had a more complicated history than his American-trained counterparts. He had graduated from the University of Panama’s medical school and completed a research fellowship at home before securing a University of Miami/Jackson Memorial Hospital internal medicine residency followed by an endocrinology fellowship at National Institutes of Health in Bethesda, Maryland.
Even though the FCVS process was difficult initially, Marquez, now assistant professor of medicine and Hallett staff member, anticipates an easier process in the future. “They do the paperwork,” he says. “You only have to deal with things unique to the state.”
Promptness counts. Whatever your background, your cooperation is one of the biggest variable in the turnaround time. You’ll slow the process if your application is incomplete or you don’t reply adequately. After all, most medical and osteopathic boards are relatively small operations processing large volumes of information to vet applicants. For example, Thompson says her unit of four “dedicated licensing gurus” works tirelessly in servicing both physicians and physician assistants. Yet they can’t advance applications without cooperation.
“It helps the whole process if the person on the other end of the conversation communicates well and understands that our team licenses 2,500-plus practitioners per year,” Thompson says.
Do everything possible to accommodate board requests and work within their constructs and deadlines. Follow directions, respond quickly and give complete answers.
“We all understand physician applicants are busy,” says Caldwell. “But if you don’t respond, somebody can’t act.”
Be file smart
A good CV will help you secure a position that matches your abilities and aspirations, and hopefully, you haven’t experienced anything that casts doubt on your skills or your character. However, any number of issues can raise red flags for both boards and employers, so you can’t be content with just what you’ve put on paper. Just in case there’s a snafu in your background, it’s to your advantage to review what others might say about you.
Research like a sleuth. In a best-case scenario, you would have documentation of any dust-ups with superiors, brushes with the law or other potentially egregious acts, but don’t assume you know everything about your own record. “Sometimes physicians aren’t aware that anything negative exists about them,” Caldwell says. “Or they were told unofficially that an incident wouldn’t be reported if it were mediated, but it’s reported. What we often hear is ‘I didn’t know.’”
So how do you avoid surprises? The ideal time to sort out potential issues is when the experience is fresh in your mind, such as after medical school or when an event occurs in residency or fellowship. But it’s never too late to circle back to a program or primary source to make sure your interpretation squares with the record. “It’s like anything else, there can be human error,” says Craig Fowler, vice president of training, recruiting and public relations at Pinnacle Health Group in Atlanta. “You want to co-pilot yourself by verifying everything.”
The logical starting point is to talk to the people who will verify your credentials and discuss what they will report. If those conversations leave you concerned, you can meet face-to-face with anyone who influences your performance evaluations. This may be your best chance to clarify and correct erroneous information.
You have a responsibility not to hide, shade or lie about anything essential on your applications. Make your answers accurate and thorough. Don’t assume that the person processing your application will understand your intent. And remember, the disclosure is often as or more important than the original transgression. “From our perspective, it’s not always about the actual issue,” says Sipes. “It’s about the honesty and integrity on the application. It’s about being diligent in all of your answers.”
Pay personal attention. Professional matters aren’t the only issues that might interest medical boards or employers. Your private life demands honesty, too. If there’s a public record that you’ve been arrested, fined or otherwise sentenced, make sure the information is accurate and shows that you fulfilled your obligation to the court.
Being cited for disorderly conduct, public intoxication or driving under the influence may not mar your chances for licensure or a job. In fact, they may not even merit an in-depth discussion. However, if the record is wrong, you should move mountains to get it corrected and hire an attorney if necessary. If it’s accurate, offer a simple explanation as to what occurred and why it was an aberration.
For instance, Smith faced a disorderly conduct citation for underage drinking as an undergraduate. She paid the fine immediately and provided an explanation with documentation on every application. Smith sailed through each process with no follow-up questions, not even during her mandatory interview with a West Virginia licensing board member. Telling the truth helped, as did the fact that it was a minor offense in the distant past. “Because it had been so long ago and I hadn’t had any problems since, it wasn’t a big deal,” Smith says. “My explanation was more than enough.”
All is not lost. Setbacks in your past won’t necessarily derail your professional ambitions. Patient- and career-endangering patterns or serious felonies may keep you from getting licensed or hired. After all, the first order of business for every state medical/osteopathic board is protecting the public, and hiring gatekeepers don’t want inept or unscrupulous practitioners in their ranks.
But not every mistake is onerous enough to delay a license or nix a job. Neither will changing medical schools, switching residencies or taking a leave of absence from training. Board administrators recognize that intervening events happen.
Fowler, for example, recalls meeting residents who had legitimate gaps in their training because Hurricane Katrina forced them to leave Louisiana. As long as you have a plausible explanation and can show that you’re an otherwise stellar performer in good stead with your current superiors, an interruption or alteration won’t necessarily ring alarm bells.
However, anything that casts doubt on your professionalism, skills or abilities will raise questions from medical/osteopathic boards and hiring teams. If you’ve undergone repeated or extended remediation, your situation likely will trigger a higher degree of scrutiny and concern than if you were able to cure your training woes by correcting them quickly.
Even if you’ve veered off track and needed special monitoring, you aren’t necessarily out of luck as long as you’re candid in your explanation and your record is otherwise exemplary. “Probation is not a death knell in any way shape or form,” Fowler says. “It just means that you had a lapse. You mediated it. Then you moved on.”
You have a full plate when it comes to building your job-search plan. You’ll need to update your CV, sharpen your interview skills and network through recruiters, job fairs, and other resources, and you should pay similar attention to essential tasks for practicing independently. Understanding licensing, credentialing and your work files should be at the top of your to-do list.
More alluring parts of your job search may demand your time and energy, but don’t ignore these bread-and-butter elements. As Fowler notes, “In launching your career, it’s easy to overlook the least exciting tasks of your search because you’re so focused on the obvious, more exciting ones. But in the midst of the chaos created by CVs, networking and interviewing, don’t forget your license, credentials and personal file. They’re critical to your next step.”